In Yesterday’s press briefing, the World Health Organization (WHO) emphasized that there is currently no treatment that has been proven to be effective against COVID-19. This warning came after President Trump tweeted about a combination of drugs touted as a highly promising treatment for the disease, backed by inadequate evidence so far.
“Using untested medicines without the right evidence could raise false hope and even do more harm than good, and cause a shortage of essential medicines that are needed to treat other diseases,” WHO Director-General Tedros Adhanom Ghebreyesus urged.
Whilst small, observational, and non-randomized studies looking at the potential of several drugs for treatment have already sprung up and are good to see, they will not give us the answers that we need, Ghebreyesus continued.
Therefore, WHO has launched SOLIDARITY, a global megatrial of the four most promising coronavirus treatments, “to generate robust, high-quality evidence as fast as possible.” These treatments include a drug combo already used against HIV (ritonavir/lopinavir), that same combination plus interferon-beta, a malaria treatment first tested during World War II (chloroquine and hydroxychloroquine), and a new antiviral originally developed to combat Ebola (remdesivir).
A European trial coordinated by the French biomedical research agency, INSERM, was also announced on Sunday and will trial the same drugs as WHO, with the exception of chloroquine.
This unprecedented effort by WHO could see many thousands of patients in dozens of countries receive one of the randomized treatments being tested. The study has also been designed to minimally impact the work of physicians, so that even the hardest hit hospitals can participate.
“This trial focuses on the key priority questions for public health,” Ana Maria Henao Restrepo, a medical officer at WHO’s Department of Immunization Vaccines and Biologicals, explained in a press briefing. “Do any of these drugs reduce the mortality, do any of these drugs reduce the time the patient is in hospital, and whether or not the patients receiving any of the drugs needed ventilation or an intensive care unit.”
Henao Restrepo told Science that WHO’s shortlist of drugs were chosen by a panel of scientists, due to their likelihood of working, the large amount of safety data from previous uses, and the availability of the drug if the trial shows they work.
But what do we know about these drugs so far?
Perhaps the drug with the most potential is remdesivir. Originally developed to combat Ebola, the drug reduces viral replication by inhibiting a key viral enzyme. Individual cases of COVID-19 who were treated with drug have recovered, but large-scale evidence is needed to see whether the drug is safe and effective.
You may recall that last week a small trial found disappointing results for the use of the drug combination ritonavir/lopinavir as a treatment for COVID-19. However, the drug combo usually used to treat HIV infections has proven to be effective in treating marmosets infected with the MERS coronavirus. Therefore the two antivirals, also teamed with interferon-beta (a molecule involved in regulating inflammation in the body), are included in WHO’s trials.
The anti-malarial drugs chloroquine and hydroxychloroquine were not originally included in WHO’s testing list, but the “significant attention” that the drugs have received in several countries, including from President Trump, has “prompted the need to examine emerging evidence to inform a decision on its potential role.” In China alone, at least 13 clinical studies are examining chloroquine’s effectiveness to treat COVID-19, whilst scientists in both Australia and the US have also looked into the drug’s potential.
As these clinical trials continue it is important to remember that currently there are no specific treatments or cures for coronavirus infections. For those with mild symptoms, COVID-19 is best treated at home with acetaminophen-based medicines (paracetamol), leaving those with advanced cases to be treated at the hospital by medical professionals.